HomeMy WebLinkAboutMortgage_Hawkins (3) �, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� 1 �;� .
•; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 Department 0.15)
Prescribed by Department of Local Government France
File
INSTRUCTIONS:
be in person or by mail FEB 1 4 Haan filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro•-'. is . , rI . my Auditor
bested on or before January 5 of the immediately succeeding calendar year gC '• i r liktil County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coon&AuditENWSIO NT i •
where the properly is located during the twelve(12)months before Mardi 31 of each
year the reduction is sou i
See reverse side nor additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse )
•
ter, „� a y2,4(n
T District Key n /legal description Record number Page number
"y/'yi.rrti. ./. aG-/9-O/- 4/og-coo, S93- £t2 a0/7 3/7
Assessed Yale of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment dabs,anent year assessment date,current year date of application legal or equitable owner?
8"4 27# ❑ Ya------No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom-
90\If name on record is different than that of appfican�indicate tabor: I�tfw''
• gip••
Name r:ortgageeor contract seller S)t Cl
Address of mortgagee or contract sell (number and street city,state,and ZIP code)
C�`. 0 1�• •• [.1 t 1�
Name of assignee or other owner or holder of mortgage •
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other ❑Yes El No - current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner f contract buyer of the aforementioned property on date application is filed.
Signature(owners fug name) Date(month,day,year)
(
Furl resident address of applicant(nu •- and-•-=,• state,and ZIPcode) 5 t
. . 0. �^ S4a N, l fve.E,'f- n webks ut(lQ, cc Y266,C•
Person authorized by duly executed • - of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.